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Hospital Readmissions Reduction Program: Keys to Success

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Avoidable readmissions are a major financial major problem for the healthcare industry, especially for government payers. To tackle this problem, CMS launched the Hospital Readmissions Reduction Program (HRRP). While some hospitals may be able to absorb the financial penalties under HRRP, they still need to track increasingly complex reporting metrics. Most tracking solutions are inadequate for today’s complicated reporting needs. A healthcare enterprise data warehouse and analytics applications, however, are designed to solve the numerous reporting burdens. When used together, they also deliver a robust solution that enables hospitals to track and drive real cost and quality improvement initiatives, all without the need for users to be technical experts.

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Hospital Readmissions Reduction Program: Keys to Success

  1. 1. Hospital Readmissions Reduction Program: Keys to Success ̶̶ Bobbi Brown
  2. 2. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Reducing Readmissions Medicare penalizes hospitals when they don’t meet readmission benchmarks. Although hospitals reduced avoidable readmissions for Medicare patients by about 100,000 in 2015, and by a total of 565,000 since 2010, there’s still much room for improvement. The federal government has estimated the annual cost of Medicare readmissions to be $26 billion per year with $17 billion of that considered avoidable.
  3. 3. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Reducing Readmissions CMS first addressed this financial problem back in 2009 by publicly reporting hospital readmission rates on the Hospital Compare website. CMS claimed the public reporting of readmission metrics would increase the transparency of hospital care, help consumers choose a care venue, and provide a benchmark for hospitals in their quality improvement efforts.
  4. 4. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Reducing Readmissions In 2012, CMS launched the Hospital Readmissions Reduction Program (HRRP), which began to penalize hospitals with high rates of readmissions for acute myocardial infarction, heart failure, and pneumonia. In 2013, the Medicare payment reduction (penalty) was one percent of the base rate, increasing to two percent in 2014, and capped at three percent going forward from 2015. Also in 2015, chronic obstructive pulmonary disease (COPD) and total hip and knee arthroscopy were added to the program.
  5. 5. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Hospital Readmissions Reduction Program Results CMS Estimated readmission penalties under the HRRP program as follows: 2013 – 8.0% of hospitals paid a 1% penalty 2014 – 0.6% of hospitals paid a 2% penalty 2015 – 1.2% of hospitals paid a 3% penalty The average penalty among those hospitals penalized rose from 0.42 percent to 0.63 percent over those three years. This amounted to between $125,000 and $164,000 per hospital. 2013 2014 2015 READMISSION PENALTIES (millions) $290 $227 $428
  6. 6. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Hospital Readmissions Reduction Program Results The $164,000 is a drop in a bucket compared to overall Medicare expendi- tures and the massive budgets of many of the health systems affected. Absorbing these losses may not be a challenge for some hospitals. Even if hospitals can absorb the financial hit, they still need to track reporting metrics—and doing so will become increasingly complex.
  7. 7. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Keeping up with Tracking and Reporting Demands CMS places its share of tracking and reporting demands on the nation’s hospitals, but the burden increases with pressures from other entities, as well. State and federal regulations, licensing, private payer initiatives, and accredit- ation bodies all require reports. Standards of transparency demand additional reported metrics that consumers use to make care decisions.
  8. 8. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Keeping up with Tracking and Reporting Demands Solution, Part 1: The Enterprise Data Warehouse So what can a hospital do to keep up with these rising demands? The answer is straightforward: adopt a healthcare enterprise data warehouse (EDW) to meet the many reporting demands. Here are a few examples of how an EDW helps solve the reporting burden:
  9. 9. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Keeping up with Tracking and Reporting Demands Solution, Part 1: The Enterprise Data Warehouse Users can access integrated views of financial, clinical, and operational data from throughout the enterprise. Data collection and the analysis process become automated. Manual data collection and tracking simply won’t work in the future. These manual processes consume time and resources and often result in inaccurate or missing information. Users can collect data from across the enterprise to integrate clinical, financial, and operational data from inpatient and outpatient settings. Reports are generated automatically, ensuring that the right data gets to the right audience at the right time. > > > >
  10. 10. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Keeping up with Tracking and Reporting Demands Solution, Part 1: The Enterprise Data Warehouse The benefits of an EDW don’t end with reporting, though. An EDW delivers the business intelligence tools a hospital needs to drive real cost and quality improvement initiatives. In specific, an EDW enables health systems to: Establish a baseline for all quality measures Perform analytics to pinpoint opportunities for improving quality Track the success of improvement interventions Measure and sustain results over the long term > > > >
  11. 11. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Keeping up with Tracking and Reporting Demands Solution, Part 2: Analytics Applications Once an EDW is in place, the organization has a foundation to adopt analytics applications. Analytics is a powerful tool that enables non- technical users to make sense of the data and discover the best areas to make changes. There are different types of improvement applications that provide an array of solutions. • Clinical analytics • Financial analytics • Operations and performance analytics
  12. 12. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Keeping up with Tracking and Reporting Demands Solution, Part 2: Analytics Applications Effective improvement applications apply to different categories, including care management and patient relationships, population health and accountable care, and research informatics. Effective analytics solutions share one important trait: non-technical users gain an easy and intuitive way to ask complex questions of the data stored within the EDW. Nobody needs to be a programmer or wait weeks or months for a custom-built report.
  13. 13. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Reducing Heart Failure Readmissions From improved reports to driving improvements, the benefits of an EDW and analytics applications are many. In fact, one large health system reduced heart failure readmissions by using an EDW as a foundation for its advanced analytics applications. First, the system implemented an EDW to quickly pool financial, operational, patient satisfaction, and clinical data from the inpatient EHR and other major information systems.
  14. 14. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Reducing Heart Failure Readmissions With the technology infrastructure in place, the team in charge of the initiative crafted specific, measurable objectives by October 2014: 30 percent reduction in the 30-day all-cause readmission rate 15 percent reduction in the 90-day all-cause readmission rate for patients with heart failure Sustain the reductions through 2016 > > >
  15. 15. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Reducing Heart Failure Readmissions Next, the team outlined specific interventions based on best practices that would move them toward their goal. Interventions included: Medication reconciliation – Within 48 hours of discharge, a physician reviews a list of the patient’s medications with explicit instructions to the patient about how to properly take them. Post-discharge appointments – Before being discharged, nurses schedule patients for follow-up care. When possible, patients at high risk for readmission are scheduled to be seen within seven days of discharge. Post-discharge phone calls – Within a specified timeframe following discharge, a member from the care team calls patients to assess their condition and answer any questions. > > >
  16. 16. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Reducing Heart Failure Readmissions An integrated dashboard was created in the healthcare EDW platform for each of the three interventions. This enabled clinicians and adminis- trators to track where the interventions were being applied. They could also track the impact the changes were having on readmissions. Even more, the EDW and analytics applications allowed the team to assess the impact of the interventions on costs and patient satisfaction.
  17. 17. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Reducing Heart Failure Readmissions The results have been impressive. Just six months after implementing the EDW, the health system achieved: A 21 percent seasonally adjusted reduction in 30-day heart failure readmissions A 14 percent seasonally adjusted reduction in 90-day heart failure readmissions A 63 percent increase in post-discharge medication reconciliation It is well on its way to meeting—and even exceeding—its objective. > > >
  18. 18. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Right Technology Can Reduce Readmissions Reducing readmissions contributes significantly to lowering the overall costs of healthcare in U.S. hospitals, but tracking the metrics and reporting the results can be onerous. The process is greatly facilitated by analytics applications supported by an enterprise data warehouse to guide improvement projects. These are the keys to developing best practices that will ultimately help hospitals reduce readmissions, and avoid the penalties that result from noncompliance.
  19. 19. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. For more information: “This book is a fantastic piece of work” – Robert Lindeman MD, FAAP, Chief Physician Quality Officer
  20. 20. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. More about this topic Link to original article for a more in-depth discussion. Hospital Readmissions Reduction Program: Keys to Success How to Survive CMS’s Most Recent 3% Hospital Readmissions Penalties Increase Bobbi Brown, Vice President of Financial Engagement How to Reduce Heart Failure Readmission Rates: One Hospital’s Story Health Catalyst Success Story 4 Ways to Reduce Penalties Under the Hospital-Acquired Condition Reduction Program Bobbi Brown, Vice President of Financial Engagement; Michael Barton, Engagement Executive, VP
  21. 21. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Bobbi Brown is the Vice President of Financial Engagement for Health Catalyst. Ms. Brown started her healthcare career at Intermountain Healthcare supporting clinical integration efforts before moving to Sutter Health and, later, Kaiser Permanente, where she served as Vice President of Financial Planning and Performance. Ms. Brown holds an MBA from the Thunderbird School of Global Management as well as a BA in Spanish and Education from Misericordia University. She regularly writes and teaches on finance-related healthcare topics. Other Clinical Quality Improvement Resources Click to read additional information at www.healthcatalyst.com

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